2324 100TH ST SE 2019-09-19 - Laserfiche WebLink

E ELECTRICAL PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET EVERET T,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov i www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: at )004h< ' ck BUILDING AREA: _sq ft M.. PROJECT TYPE: ❑NEW CONSTRUCTION ❑ADDITION CfI TENANT IMPROVMENT ❑ REMODEL BUILDING USE: arA SFR n TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION 8 DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ 90D.007 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: ntt004.4,Q4-_, 0,4._ Evac THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPY) LINE VOLTAGE WORK? El0 YES-Select Scope:❑ Service ❑Feeder Circuits-#: I ❑ Complete Re-wire LOW VOLTAGE WORK? ( f1 NO CIYES-#of Devices; SELECT SCOPE(REQU'RED): ❑ Data ❑ Intercom ❑Thermostat ❑Audio ❑ Secure Access ❑ Security System H Fire Alarm- Installations under this permit only include electrical wiring rough-in of the system.An.additional Fir Alarm Permit is required for review of dev ce location and installation approval. Other(List All):_010$1.1 CODE COMPLIANCE IS THIS PERMIT EDUCATION, INSTITUTIONAL, HEALTH AND/OR PERSONAL CARE FACILITIES: NO T1 YES--See Below&Pg. 2 F--1 By checking this box, I am stating that I have read and understand all of WAC 296-46B-900,selected the specific reason on page 2 of this application(see next page), AND Plan Review is NOT required because I meet all of the following sub sections that do not See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: -,NO .,..YES-See Below&Pg. 3 Pursuant to RCW 19.28..261,property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease without the proper electrical licensing and certification,or exemption. By checking this box, I am stating that I have completed and See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement: CONTACT INFORMATION OWNER NAME: ACI1S1 TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: :;-FE-ET �1D1-1 D b , CITv i 4 .. S-Atn= 0 z o Cf ae)(8 OWNER PHONE:( alt,\\. C1 OWNER EMAIL: 1 I CONTRACTOR NAME: Tie,„(\ C Qt 4 2 1? Ci CONTRACTOR ADDRESS: srRrrT V `jj�(7�ytj (! 1. � Y.T3fix4 �� t CONTRACTOR PHONE_ i� w T ,, v CONTRACTOR EMAIL: ‘(K1 r 4 1cie 'P t CONTRACTOR LIC.#(141 QUli,: 0); A I icE t (t�, CITY OF EVERETT BUSINESS LIC.#(RFQUIfifF.D): 4, °A Q PRIMARY CONTACT: DOWNER t,.CONTRACTOR [_,OTH 1ER(Please Specify) W ......... CON CT NAME: CONTACT PHONE:NS) 419, n L � NIA CONTACT EMAIL: jy(;°�'� teoc. OMAt Rk L MLN!:l here! cortif that 1 have teed#and extintrncrd#tris " �� lY ' Y +s�)iliCafitut 3rtd ktttitie the S)Ark.Vip-sit)c) lrrr3 do bee and correct. All prt7t!ia;tOrts of lair and ordinances governing Mrs type of work will be completed whether specified herein or not the granting of a permit does riot presume to give authority to violate or cancel the provisions of any other state or iocai taw regulating construction or the performance of construction. That I em authorized by the owner of this property to perform the work for which application is made ano l comply with the State Contractors Law 1827 RCW and 296.200 WAD. City of Everett Official Use Only PERMIT#: 71? E 1g0�- oW r/Authorized Agentbl,;)q,-;-4 ature Date (Revised 111T12019) Page 1-Application